Ehsanullah Alokozay

Background and Aims: Colorectal cancer (CRC) and type 2 diabetes mellitus (T2DM) are significant contributors to global morbidity and mortality, with growing evidence suggesting a synergistic impact on disease outcomes. This research focused on analyzing trends in CRC‐related deaths among individuals with coexisting T2DM in the United States from 1999 to 2023, as well as exploring disparities among different demographic and geographic groups. Methods: Data were obtained from the CDC WONDER database for deaths among adults aged ≥ 45 years with CRC as the underlying cause and T2DM as a contributing cause. Age‐adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population. Temporal trends were analyzed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CI). A two‐sided p < 05 was considered statistically significant. Results: From 1999 to 2023, there were 22,392 recorded deaths. The overall age‐adjusted mortality rate (AAMR) increased from 0.55 to 1.04 per 100,000 people, with an average annual percentage change (AAPC) of 2.55% (95% CI: 2.18–3.06; p < 001). Men experienced higher mortality rates than women, and individuals aged ≥ 65 years had higher rates than those aged 45–64. Significant racial disparities were evident, with the highest AAMRs among Hispanic and non‐Hispanic Black groups. Geographically, the West had the highest AAMRs and the steepest increase over time. Rural areas consistently showed higher AAMRs compared to urban areas. Most deaths (44.06%) occurred at home. Conclusion: CRC‐related mortality in individuals with coexisting T2DM has risen sharply in the US over the past twenty years, showing significant demographic and geographic differences. These results highlight the importance of implementing targeted, integrated prevention and management approaches to decrease the combined impact of CRC and T2DM. The Detailed Visual Abstract is illustrated in the Central Illustration.

Background: Ischemic heart disease (IHD) remains a leading cause of mortality in the United States, while arrhythmia‐related deaths are increasing. However, long‐term mortality trends involving both conditions remain unclear. Methods: We utilized the CDC WONDER Multiple Cause‐of‐Death database to obtain records from 1999 to 2023, targeting US adults aged ≥ 25 years. Deaths involving IHD and arrhythmias were assessed. Age‐adjusted mortality rates (AAMR) were calculated and stratified by gender, age, ethnicity, census region, and urbanization. Results: A total of 1 795 918 deaths were attributed to both IHD and cardiac arrhythmias between 1999 and 2023. The AAMR declined from 41.97 (95% CI: 41.66−42.27) in 1999 to 32.73 (95% CI: 32.51−32.94) in 2023, representing an overall decrease of 22% (AAPC −0.99). Men had higher AAMRs compared to women (45.0 [95% CI: 44.6−45.5] vs. 23.4 [95% CI: 23.2−23.7]). The highest mortality rate was observed among NH White individuals (AAMR: 34.8; 95% CI: 34.5−35.0), while the lowest was among NH Asian or Pacific Islanders (AAMR: 16.5; 95% CI: 15.6−17.5). Older adults exhibited the higher AAMRs (144.74; 95% CI: 143.60−145.88) compared to younger cohorts. An increased death burden was observed in non‐metropolitan (AAMR: 37.1; 95% CI: 36.5−37.8) and Midwest regions (35.5; 95% CI: 34.9−36.0). The majority of the deaths occurred in inpatient facilities (34.7%). Conclusions: Although IHD–arrhythmia mortality declined between 1999 and 2023, substantial disparities persisted across demographic and geographic subgroups, highlighting the need for targeted public health interventions.

Background: Baxdrostat is a selective aldosterone synthase (CYP11B2) inhibitor for treatment‐resistant and uncontrolled hypertension, evaluated in phase 2/3 RCTs. Objectives: To estimate pooled placebo‐corrected reductions in seated office and ambulatory SBP, characterize the dose–response relationship, assess cortisol selectivity, and quantify hyperkalemia risk. Methods: We conducted a systematic review and meta‐analysis of phase 2/3 randomized, double‐blind, placebo‐controlled trials of baxdrostat in hypertension, searching MEDLINE/PubMed, EMBASE, ClinicalTrials.gov, and NEJM.org to March 2026. The primary outcome was placebo‐corrected change in seated office SBP, analyzed using random‐effects meta‐analysis (REML) with metafor in R. Risk of bias and certainty were evaluated using Cochrane RoB 2.0 and GRADE, respectively. Results: Three RCTs (BrigHTN, BaxHTN, Bax24; N = 1285) were included. The pooled seated SBP reduction was −9.44 mmHg (95% CI: −11.09 to −7.79; I ² = 0.0%), with dose subgroup estimates of −8.57 mmHg (1 mg) and −10.11 mmHg (2 mg) and a clear dose–response in BrigHTN (slope −4.2 mmHg/mg; R ² = 0.96). Bax24 demonstrated a 24 h ambulatory SBP reduction of −14.0 mmHg (95% CI: −17.2 to −10.8). Serum cortisol was unsuppressed at all doses, while the pooled OR for potassium ≥ 6.0 mmol/L was 5.14 (95% CI: 1.76 to 14.97). GRADE certainty was moderate for seated SBP, low to moderate for ambulatory outcomes, and low for hyperkalemia. Conclusions: Baxdrostat produces meaningful, selective BP reductions across hypertensive populations. Hyperkalemia is manageable with structured monitoring. Certainty is limited by a few trials, a short follow‐up, and safety imprecision. Long‐term cardiovascular outcome data are needed before guideline incorporation.

Cancer remains the second leading cause of death in the United States (U.S.), with increasing incidence among younger adults. Sepsis, a life-threatening organ dysfunction caused by infection, frequently complicates cancer due to disease-related and treatment-induced immunosuppression. Understanding cancer–sepsis mortality trends is essential for identifying high-risk populations and improving prevention and clinical management strategies. We analyzed U.S. mortality data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death database to identify deaths among adults aged ≥ 25 years in which both cancer (International Classification of Diseases, Tenth Revision C00–D48) and sepsis (International Classification of Diseases, Tenth Revision A41) were listed on the same death certificate, representing concomitant cancer–sepsis mortality. Age-adjusted mortality rates per 100,000 population were calculated and temporal trends were assessed using Joinpoint regression. Statistical significance was set at P < .05. From 1999 to 2023, a total of 20,108,555 U.S. adults aged 25+ died from cancer complicated by sepsis. From 1999 to 2023, the average annual percentage change (AAPC) decreased by 1.09% (95% confidence interval, −1.33–−0.84%). Rates fell from 417.6 per 100,000 in 1999 to 322.0 in 2023, showing a steady decline until 2018 (annual percent change [APC]: −1.32%), a brief rise from 2018 to 2021 (APC: 2.17%), and a significant drop from 2021 to 2023 (APC: −3.65%). Mortality was highest in men (AAPC: −1.33%) and Black or African American individuals (AAPC: −1.68%), as well as in nonmetropolitan areas (AAPC: −0.60%) and the Southern U.S. (AAPC: −1.02%). Most age groups experienced significant declines, particularly middle-aged adults, while the youngest (25–34) and oldest (85+) age groups showed minimal long-term change. All racial and ethnic groups showed improvement, although American Indian or Alaska Native trends remained largely flat until a notable decline (APC: −8.26% from 2021 to 2023). Most deaths occurred in hospitals (38%) or at home (35%), with fewer in nursing homes, hospices, or other settings. Concomitant cancer–sepsis mortality declined overall in the U.S. from 1999 to 2023, but substantial disparities persist by sex, race/ethnicity, geography, and urbanization, reflecting inequities in access to oncology care, critical care, and timely sepsis management.

Relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) remains a therapeutic challenge, particularly for patients ineligible for stem-cell transplan

Despite advances in human immunodeficiency virus (HIV) treatment, disparities in HIV-related mortality persist across demographic groups in the United States. The COVID-19 pandemic disrupted healthcare systems and may have influenced established mortality trends. This study evaluates HIV-related mortality in the U.S. from 1999 to 2023, with emphasis on changes following the onset of COVID-19. Data were obtained from the CDC WONDER database, identifying HIV-related deaths (ICD-10: B20–B24) among adults aged 25 to 85+. Age-adjusted mortality rates (AAMR) per 100 000 were calculated. Trends were analyzed using Joinpoint regression to estimate annual percent changes (APCs) and average annual percent changes (AAPCs). From 1999 to 2023, there were 271 932 HIV-related deaths in the U.S. The overall AAMR declined by an AAPC of −4.34%, with a slower post-COVID decline of −4.19% ( P < 0.05) from 2020 to 2023. Gender-stratified analysis showed greater post-COVID declines in women (APC: − .58%) than in men (APC: −3.90%). Older adults (85+) experienced a post-COVID increase in mortality (APC: +12.37%). Urban centers showed an APC increase (+2.33%), while rural areas continued to decline. Racial disparities narrowed modestly. Black and Hispanic populations saw sharper post-COVID declines (APCs: −6.21% and −6.26%, respectively) compared to White populations (−1.33%). The Southern U.S. remained the highest-burdened region across both timeframes. Observed mortality trends were temporally associated with demographic characteristics and urbanization patterns during the COVID-19 period. While HIV mortality continues to decline, the COVID-19 pandemic has disrupted progress, especially among elderly and urban populations. Persistent disparities demand targeted, equitable public health interventions.

Background: Optimal positive end-expiratory pressure (PEEP) is essential for maintaining alveolar recruitment and preventing postoperative pulmonary complications (PPCs). Traditional fixed PEEP strategies may not account for individual variations in lung recruitability. Electrical impedance tomography (EIT) offers real-time assessment of regional ventilation, enabling individualized PEEP titration that balances alveolar collapse and overdistension. This systematic review and meta-analysis evaluated the effectiveness of individualized EIT-guided PEEP compared with fixed PEEP in reducing postoperative atelectasis and improving perioperative outcomes. Methods: This review followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251169858). Randomized controlled trials (RCTs) involving patients undergoing laparoscopic surgery under general anesthesia were eligible if they compared EIT-guided individualized PEEP with fixed PEEP (5 cmH₂O). Primary outcome was postoperative atelectasis assessed by lung ultrasound. Secondary outcomes included mean arterial pressure (MAP), PaO₂/FiO₂ ratio, PaCO₂, pH, dynamic lung compliance, crystalloid use, urine output, length of hospital stay (LOS), intraoperative blood pressure complications, bradycardia during recruitment maneuvers or PEEP titration phases. Data were synthesized using a random-effects model, and heterogeneity was assessed using I² statistics. Leave-one-out sensitivity analyses evaluated the robustness of results. Results: Five RCTs ( n = 290) met inclusion criteria. Individualized EIT-guided PEEP significantly reduced postoperative atelectasis (OR: 0.18, 95% CI: 0.06–0.51) and improved oxygenation (PaO₂/FiO₂ ratio SMD 1.72, 95% CI: 0.45–2.98). MAP was modestly higher in the EIT group, while bradycardia during recruitment or titration phases occurred more frequently. No significant differences were observed in lung compliance, hospital stay, urine output, or metabolic parameters. Sensitivity analyses confirmed the stability of key findings. Conclusion: Individualized PEEP titration guided by EIT reduces postoperative atelectasis and enhances oxygenation without adversely affecting most perioperative outcomes. Despite encouraging results, larger multicenter trials are needed to validate these findings and guide clinical implementation.

Gastric cancer (GC) remains a major cause of cancer-related mortality worldwide, driven by multiple risk factors including infection, diet, genetics, and lifestyle behaviors. Tobacco use is a well-established modifiable risk factor that contributes to gastric carcinogenesis through chronic mucosal injury. This study aimed to evaluate long-term mortality trends of tobacco-associated GC among United States adults aged ≥ 25 years. We conducted a retrospective cross-sectional analysis using the CDC WONDER Multiple Cause of Death database from 2003 to 2023. Adults aged ≥ 25 years with GC (International Classification of Diseases, Tenth Revision: C16) and tobacco use disorder (International Classification of Diseases, Tenth Revision: F17) listed as underlying or contributing causes of death were included. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Temporal trends were assessed using Joinpoint regression, reporting annual percent change and average annual percent change (AAPC). A total of 17,357 deaths were attributed to tobacco-associated GC (overall AAMR: 0.34). Mortality was higher among males (AAMR: 0.58) compared with females (AAMR: 0.15), with comparable temporal trends (AAPC: 4.59% vs 4.58%, respectively). Overall AAMR increased significantly from 0.15 in 2003 to 0.40 in 2023 (AAPC: 4.60%; 95% confidence interval: 3.11–6.18). Across racial groups, non-Hispanic (NH) Black individuals exhibited the highest mortality burden (AAMR: 0.56). However, NH White individuals demonstrated the steepest relative increase over time (AAPC: 3.89%). Regionally, the Midwest had the highest mortality burden (AAMR: 0.45) and the fastest growth (AAPC: 7.33%). Nonmetropolitan areas showed higher mortality (AAMR: 0.45) and a greater increase (AAPC: 4.73%) than metropolitan areas (AAMR: 0.33; AAPC: 4.14%). Tobacco-associated GC mortality has increased significantly in the United States from 2003 to 2023. While NH Black individuals bear the greatest overall mortality burden, NH White individuals exhibit the steepest rise in mortality rates. Higher burden and growth in the Midwest and rural areas highlight persistent geographic disparities.